1146 The Impact of Smoking Status on Female Patients With Intracranial Aneurysms: An NIS Analysis

INTRODUCTION: Female sex is a known risk factor for intracranial aneurysms and increased rupture risk. Smoking history also increases the risk of aneurysm rupture. While the association between smoking and intracranial aneurysms in female smokers is recognized, the rupture risk remains unclear. METHODS: We queried the National Inpatient Sample for female patients diagnosed with intracranial aneurysms from 2003 to 2020. Female smokers and non-smokers were compared after a KNN matching (1:1) by race and age. Multivariate logistic regression and random forest classifiers were used to identify preoperative characteristics, postoperative outcomes, and predictors of aneurysm rupture. RESULTS: The study included 32,530 females with intracranial aneurysms: 20,753 non-smokers and 11,777 smokers. Smokers exhibited a significantly higher rupture rate (p<0.001). Matched analysis revealed higher microsurgical treatment rates in smokers and endovascular treatment rates in non-smokers (p=0.001). Smokers experienced longer hospital stays and higher healthcare costs (p<0.001). Hemorrhagic stroke, neurological and pulmonary complications, and DVT/PE were more frequent in smokers. Multivariate logistic regression showed female smokers had higher odds (1.15) of rupture (p<0.001). Endovascular treatment, white and black race, dyslipidemia, diabetes, and long-term aspirin or anticoagulant use increased the rupture odds. Among smokers, age, endovascular treatment, dyslipidemia, diabetes, and long-term aspirin use were associated with higher rupture odds, while hypertension and black and white races were protective. Smoking status had the highest association coefficient linked to rupture. SHAP features importance analysis using the Random Forest classifier (AUC=0.8) identified age and smoking status as the top predictors of rupture. CONCLUSIONS: Female smokers have a significantly higher risk of intracranial aneurysm rupture compared to non-smokers. These findings underscore the importance of smoking cessation and monitoring of female patients with intracranial aneurysms, particularly those with additional risk factors.